Acquired Brain Injury Action Plan

John Hayes Excerpts

Thursday 4th December 2025 Westminster Hall

[Sir John Hayes (South Holland and The Deepings) (Con) [R]]

I beg to move,

That this House has considered the potential merits of a comprehensive acquired brain injury action plan.

Dickens wrote,

“Reflect upon your present blessings—of which every man has many—not on your past misfortunes, of which all men have some.”

There are few greater misfortunes than an acquired disability. Among those, a brain injury can challenge every aspect of life, whether people can walk, talk or think—or at least think straight. The effects are various: they can be mild or severe, and recovery will often take not just weeks or months, although the initial trauma can be treated in that timeframe, but many years. However, an improvement can be made over the long term.

Most of us think, “This will never happen to me.” I guess that is true of most misfortunes, including ones of this severity. Brain injury is the leading cause of disability and death among people under 40 in the UK. It can happen at any time, in any place. The causes, again, are various. One thinks of sporting injuries, or perhaps an attack—a violent incident. Of course, the principal causes are things like road traffic accidents, motorcycle and car accidents. Acquired brain injury, for the reasons I have given, has long warranted more attention than it has received, both publicly and among policymakers.

While the Department of Health and Social Care plays a central role in dealing with the immediate trauma caused by the sorts of accidents I have described, many other Government Departments have a relationship with the effects of brain injury. That is well illustrated by the work done by the all-party parliamentary group for acquired brain injury, which I am now proud to chair, and published in a report to which I will refer later in my speech.

We made the case that a cross-departmental approach to brain injury is required, for exactly the reasons I have set out. Of course, it affects the Department of Health, but it also affects the Department for Culture, Media and Sport—I spoke about sporting injuries a moment or two ago. It affects the Ministry of Justice, because such a high proportion of the incarcerated have brain injuries. It affects almost all aspects of Government, on which I know other contributors to this debate will focus, so a lateral approach to the way that public policymakers consider brain injury and its effects is critical.

As you will know, Dame Siobhain, as an extremely experienced and very wise Member of this House, might I say—

[Dame Siobhain McDonagh (in the Chair)]

Flattery will get you nowhere.

--- Later in debate ---

[Sir John Hayes]

I was hoping it might. Lateral policymaking is not easy in Government, because of the way Government works and ministerial responsibilities are exercised. It is a challenge, therefore, to get that sort of approach adopted by a Government of any colour or persuasion.

[Mr James Frith (Bury North) (Lab)]

The right hon. Gentleman is making a typically thoughtful contribution, and I congratulate him on securing this debate. I also thank Clare Harrison, a constituent of mine, from the Brain Injury Group for bringing this important matter to my attention.

The right hon. Gentleman makes a point about the Government’s role, and as he mentioned, sporting injuries populate such issues. Among those affected are former professional footballers, who are four times more likely to develop a neurodegenerative disease, support for which is patchy. For female former professional footballers, that support is non-existent. Will he join me in encouraging the Minister to consider the creation of an independent, football-funded body, alongside any wider action plan that his APPG is advocating for?

[Sir John Hayes]

I am grateful for the hon. Gentleman’s contribution. He makes a valuable point and an interesting suggestion that I will reflect on. He is certainly right that more can be done to affect brain injury in the first place. I have spoken a bit about its effects, but he is right to speak at greater length than I did about its causes. In the area of sport, of course, he is right that we now know that heading a football does all kinds of damage that no one imagined a generation or two ago. His suggestion is well made and worthy of further consideration.

Around 350,000 people a year are admitted to hospital with acquired brain injury—that is one every 90 seconds. About 125,000 of those are admitted following a traumatic brain injury, around 43,000 with brain tumours and others following strokes. I pay tribute to Lincolnshire brain tumour support group, of which I am president, and to Headway, which I will say more about in due course. The end result of those admissions is that about 1.3 million people are living with the consequences of acquired brain injury every day. They and their families, loved ones and friends, and the communities of which they are part, are dealing with the effects.

According to our all-party group’s latest report, the cost to the UK economy through healthcare, social care, lost productivity and wider public services is £43 billion annually, which equates to 1.3% of GDP. Of that, £20 billion is accounted for within the NHS and social care budget for acute long-term care, £21.5 billion is attributed to lost productivity, £1.5 billion is spent in the criminal justice system and the Department for Education—yet another Government Department that needs to be involved in the consideration of this issue in the lateral way I mentioned—and about £1.9 billion is spent on benefits. Leaving aside the human cost and the visceral effects brain injury can have on affected individuals and those who care for them, this has a considerable effect on Government, the Exchequer and the public purse.

Those ramifications only scratch the surface of the wider social cost. The real cost is in lives disrupted, plans abandoned and ambitions jettisoned as a result of brain injury; in parents seeing a child’s personality change overnight and carers stretched to their limits, with little or no respite, because symptoms are dismissed as being mild or imperceptible or attributed to some other cause entirely. Although less obvious, those effects are just as devastating. When those costs are added to the ones I have described, the all-party group estimates that the real cost of acquired brain injury is £91.5 billion. That is about half of what the NHS spends every year. It is extraordinary that this issue is not given greater consideration. I am delighted that this debate gives us a chance to do so, at least for this short time. I thank all colleagues across the House who have been part of these efforts.

We have argued for what we call a right to rehab. Putting aside the substantial financial cost, the physical and emotional costs are still higher. The estimates do not include many of the costs associated with homelessness, addiction, mental health services and psychiatric stays. The cost to the NHS and welfare of lengthy treatment and recovery is huge and rises quickly during spells in hospital before one even receives community support and longer-term social care provision. Much of this could be prevented, and many of the costs could be reduced, if we had the right to rehab.

Much work has been done on this subject, including by Headway, which I mentioned earlier, and the United Kingdom Acquired Brain Injury Forum. A report from earlier this year, commissioned by the APPG, urged the Government to invest in specialist neuro-rehabilitation to save long-term societal costs. The report called for brain injury to be treated on a par with cancer and dementia. A statutory right to rehab in every region means that specialist neuro-rehabilitation services after an acquired brain injury would be put in place.

None of the failures that we see today in response to brain injuries is inevitable. The Ministry of Defence already guarantees the right to rehabilitation for military personnel, so we have a precedent. We want to build on that precedent, across Government, for those affected by brain injury.

We know from the MOD the results of having that right for rehabilitation—shorter recovery times, better outcomes, restored lives and improved prospects. The same approach is being piloted by the National Rehabilitation Centre, where every £43,000 invested in rehab yields savings of up to £680,000. That is a remarkable 16:1 return on investment.

Now is the time to extend the entitlement adopted by the MOD much more widely. We must establish a national neuro-rehabilitation framework that guarantees that access to specialist care is not a lottery, but a certain path to recovery. In doing so, money would certainly be saved, but life chances would be improved immeasurably, too. High-quality rehabilitation reduces the risk of homelessness, addiction and a drift into lawlessness. It allows people to contribute, return to work and rebuild lives and relationships—to begin to stand tall again.

Now is the time for the Government to act. I have every confidence that the Minister will rise to her feet at the summation of this debate and tell us that she has not only thoroughly studied the all-party group’s report—daily, perhaps—but that she is ready to respond in the way that we invite.

I pay tribute to the hon. Member for Rhondda and Ogmore (Chris Bryant), who chaired the APPG before I did—I was his vice-chairman for many years. He drove the original version of the report, which was republished more recently. It is an outstanding piece of work. We all know that APPGs vary, but this one is focused on the subject for which it is responsible and is determined to make its voice heard, because of the all-party support it attracts and because of the salience and significance of this subject.

Given the number of people affected by brain injury, the comparatively low cost of effective interventions, such as rehabilitation and community support, and the ongoing lack of support services, there continues to be a strong need for a proper strategy to be put in place.

I spoke earlier about a lateral approach. We are calling for a national strategy on brain injury. Around 60% of prisoners report having an acquired brain injury. We discussed that at a recent APPG meeting, where we heard from experts in the field. I have served as a Minister in multiple Departments—I will not list them all—and I know that cross-departmental working is tough, and the Minister will know that too, but it can be done. It requires structures to be created that facilitate Ministers to come together. The Cabinet Office might be able to play a part. I served in the Cabinet Office and its purpose, in a sense, is to deal with those issues that could otherwise fall between the cracks and departmental silos. However it is done, we need a national strategy.

As far back as 2001, the Health Committee published a report on head injury, issuing 28 recommendations that included, as a matter of urgency, finding ways of improving methods of data collection on incidence, prevalence and severity. In 2005, the national service framework for long-term neurological conditions was launched; it contained many good ideas, but had no mandate and no funding. In 2010, the National Audit Office published a report, “Major Trauma Care in England”, which highlighted the need for improvement in major trauma care. That led to the establishment—you may remember it, Dame Siobhain—of trauma networks, with a centralised and specialised approach to trauma care and service across the country.

The excellent work of the APPG for acquired brain injury, which was reformed in 2017, showed that there was a strong case for a cross-party commitment to action. I have already spoken about the 2018 report, which called for a national reconsideration of rehabilitation and the collation of reliable statistics, given the problems with data collection and analysis that prevail.

To be fair to the previous Government, our report was well received by Ministers. Indeed, they responded to what we had called for by committing to publish a strategy on acquired head injury in 2021. The following year, there was a call for evidence to inform the development of such a strategy. The previous Government said that they were going to do it, committed to the principle and welcomed the work that we were doing. However, we then, of course, had the inconvenience of an election—one of the aspects of democracy that sometimes gets in the way of these sorts of things. Therefore, the work was not brought to a conclusion.

Earlier this year, the current Government announced their intention to develop an “action-oriented, and accountable” ABI action plan

“with input from NHS England and other Government departments”.

It was due to be published “this year”—well, the year is running out, Minister. However, there are still a couple of sitting weeks left: a statement could be brought to the House and perhaps a document could be published that responds to the calls that we have made. We have the work that the previous Government and this Government have done. There has been no party politics; over time, Ministers have recognised the challenge—the scale of the problem—and the reasons for addressing it, which I have set out.

We can hope that this Minister, who I know is dutiful and diligent, will rise to exactly that challenge. I do not know whether I am flattering her, Dame Siobhain—I am doing my best.

[Dame Siobhain McDonagh (in the Chair)]

I think that may be your modus operandi.

[Sir John Hayes]

Following representations from myself and others, the Minister, who has responsibility for public health and prevention, kindly responded to say that the Government will publish an action plan in 2026. I hope that it will be published as early as possible—if not before Christmas, perhaps as an early new year’s resolution.

After years of campaigning by charities and MPs, the excellent news is that there now seems to be momentum on this issue, which is what sufferers and their families deserve; it is what they warrant and certainly what they need. The plan needs to include a focus on better community rehabilitation and on how that will help to achieve real change for people with ABI. It could also include national training for local authority and integrated care board commissioners, and for social workers, on the complexities of ABI. I have talked about the subtlety of the effects that ABI can have, including the changed personality that many people experience as a result of a brain injury. Addressing such subtle changes requires a level of understanding and expertise, so national training could be really important and of immense value.

I hope that the plan will also include funding for community-based specialist brain injury services. Staggeringly, the vital research by Dr Alyson Norman found that a third of serious case reviews in social services involved someone with a brain injury. Dr Norman lost her own brother to suicide after he suffered a lifetime of untreated brain injuries sustained in childhood.

Given that brain injury is no less than a hidden epidemic, it is imperative that the Government take further action to collect statistics about it, so that we can accurately ascertain the numbers impacted. We need a UK-wide consensus on which conditions are classified and coded as brain injury, and to make that data freely available. Access to hospital admission data on brain injuries must be free; currently, charities face significant costs.

The charity Headway, which has done so much in this field, is not an immensely wealthy organisation and so those costs are significant to it. I hope that we get some reassurance on that point. Research by Headway has shown that over three quarters of brain injury survivors encounter daily challenges due to the hidden nature of their injury, and that nine out of 10 people affected by a brain injury cite societal misunderstanding as a major obstacle in navigating life with a hidden disability. Collecting those facts and figures is important because of the nature of acquired brain injury.

I will not say too much more about the costs to the sector, except that over the past three years several local Headway charities have permanently closed, including one in the last month. Three local volunteer branches have also shut down. That is because of rising costs of all kinds, which I do not need to list here. Closures really do risk brain injury survivors feeling lost. This is an area of work and a need that can go unrecognised and unseen. The feeling of isolation and loneliness—this is, as I described, a hidden epidemic—can place immense strain on families as survivors are no longer able to access, for example, the specialist daycare centres that they might otherwise enjoy.

We need to find a way of granting exemptions for charities from things such as the employer national insurance charges. I hope that the Minister will look at that, or even speak about it in this debate. Some 57% of Headway charities say that they have experienced delays in receiving payments from local authorities and integrated care boards. Some charities have even had to employ additional staff members purely to chase the debts that they were owed. These are small organisations with limited budgets; they just need help.

I know that other hon. Members want to contribute to the debate and can see their eagerness to do so, so I will draw my remarks to a close. For survivors, a head injury is just the beginning; the real challenge after survival lies in the days, months and years that follow. Individuals and their families struggle to navigate, with minimal support, a fragmented and underfunded system of rehabilitation. I know that because more than 40 years ago, like so many other young people, I suffered a serious head injury. But the key for me is that it did not stop me from doing what I wanted or being what I became. That is fundamental for anyone with an acquired disability.

It is a matter of record that I decided to become a Conservative MP when I was seven—I was probably six, actually. That did not alter as a result of my head injury, but it might have done. I have seen those much more seriously affected by the traumatic injury they endured. As I looked at them I thought, “There but for the grace of God go I”, so I was determined thereafter to do all I could to fight for people with serious head injuries who struggle with their effects. I have been determined to champion their cause and to turn my hopes on their behalf, and their hopes too, into reality.

I started with Dickens, one of our greatest writers, and I will end with Tolstoy, the great Russian writer. He wrote:

“As long as there is life, there is happiness. There is a great deal, a great deal before us.”

For everyone, regardless of what they suffer, to be able to glean that happiness, through the care and support that they receive, should be the ambition of every Government Minister and every Member of this House.

[Several hon. Members rose—]

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is a pleasure to serve under your chairship, Dame Siobhain. I congratulate the right hon. Member for South Holland and The Deepings (Sir John Hayes) on securing this important debate on an issue that touches many thousands of lives across the country. I acknowledge and thank all hon. Members for the stories of their constituents that they have shared today.

I begin by paying tribute to the right hon. Gentleman and the all-party parliamentary group for acquired brain injury for shining a light on what has too often been an invisible issue. Through its recent report, “Right to Rehab: The Cost of Acquired Brain Injury to the UK Economy”, the all-party group, ably supported by the UK Acquired Brain Injury Forum, has demonstrated both the human and the economic imperative for action. That report reveals the staggering £43 billion annual cost of ABI to our economy. It makes a compelling case for improved rehabilitation, cross-Government co-ordination and investment in specialist services. That work has helped to drive vital conversations across health, justice, education and beyond to ensure that people living with ABI are no longer overlooked.

Recently, I was delighted to be able to attend and speak at the UKABIF annual ABI summit last month, where I met key stakeholders, including people with lived experience, for a panel discussion on the stage and at a separate meeting afterwards. I have taken away some important calls for action from those discussions. The Government have also listened to the calls of the all-party group and others for a dedicated plan. I reassure the right hon. Member for South Holland and The Deepings and others that we remain committed to delivering on that promise.

In the coming months, in the first half of next year, I confirm that we will publish the acquired brain injury action plan, a landmark step in delivering the joined-up approach that people with ABI deserve. I also confirm that when we publish it, that plan will draw on a wide range of evidence, including the evidence that was submitted in the 2022 call for evidence. The plan will set out clear priorities across health, social care, education, justice and beyond in a bid to move towards rehabilitation and long-term support being better embedded throughout public services. It will reflect continuing engagement with clinicians, charities and people with lived experience. It will provide the blueprint for improving outcomes, reducing inequalities and supporting independence.

[Sir John Hayes]

All the Minister has said so far is incredibly welcome. On ministerial engagement, given what she said about the cross-departmental working, which I called for earlier, is she engaged with the Ministers in those Departments in drawing up the plan and, if so, how?

[Ashley Dalton]

I am just coming to that, so the right hon. Member’s intervention was very timely. As has been highlighted, the plan matters, because ABI is not just a health issue; it touches education, employment, justice, work, benefits, housing, homelessness and many other areas of life. Without co-ordinated action, too many people will continue to fall through the gaps.

In the first instance, therefore, I have started conversations with ministerial colleagues who have responsibility for education at the DFE, for the criminal justice system at the MOJ, for housing and homelessness at the Ministry of Housing, Communities and Local Government, and for work and benefits at the Department for Work and Pensions. The Department also reached out to those working on transport, sport and defence, among others, asking them to commit to tangible actions in the ABI plan. I note the suggestion of my hon. Friend the Member for Bury North (Mr Frith)—he is no longer in his place—and we will give that consideration.

The plan will build on already excellent work that is going on across Whitehall, helping to tackle the impacts of ABI directly or indirectly. That includes the Ministry of Justice’s update to its new neurodiversity action plan; working with the Department for Transport on its road safety strategy; the Department for Education’s planned consultation on an updated version of supporting pupils with medical conditions at school; and the Home Office-led work to tackle domestic abuse.

I also confirm, as was raised by the hon. Member for Bath (Wera Hobhouse), that the Government are committed to advancing research into ABI in sport. We recognise the significant impact of sports-related head injuries on long-term health outcomes. Through the National Institute for Health and Care Research, we are co-funding a major initiative, the UK traumatic brain injury platform. In addition, the Department for Culture, Media and Sport established the concussion in sport research forum, in which we are working alongside them.

We recognise that developing the plan is taking slightly longer than we had originally wished, but I reassure right hon. and hon. Members that that is not because of a lack of commitment; it is because we want to get it right. We want to take ABI stakeholders with us and to set the plan against the new health and social care landscape described in this summer’s 10-year health plan. In Manchester last month, I had the opportunity, as I said, to hear directly about potential solutions and opportunities from those at the coalface.

ABI affects every facet of life, and creating a plan that truly delivers requires co-ordination across multiple Departments and extensive stakeholder engagement, as well as alignment with wider reforms and developments such as the 10-year health plan, neighbourhood health services, new NICE guidance on rehabilitation and NHS England’s recently refreshed service specification for adult neurology services. That will mean that, although the report may be slightly delayed, it will have a comprehensive cross-Government approach to drive real change by improving rehabilitation, reducing inequalities and supporting people with ABI to live independent and fulfilling lives.

I know that the all-party group, the right hon. Member for South Holland and The Deepings, my hon. Friend the Member for Hartlepool (Mr Brash), and the Lib Dem spokesperson, the hon. Member for Mid Sussex (Alison Bennett), all recognise that rehabilitation is the cornerstone of recovery and independence. Reports from the APPG and UKABIF have made it clear that timely, specialist rehabilitation can transform lives. Rehabilitation is what turns survival into quality of life, enabling people to return to work, education and their communities. The APPG has consistently championed a statutory right to rehabilitation because it knows that too many people face fragmented services and missed opportunities, and as a result their health deteriorates once they are back in the community.

What the final action plan will say on community rehabilitation will be worked through carefully with stakeholders and with NHS England to ensure that we get it right. We must ensure that our proposals are feasible and viable. However, at the absolute minimum, it will highlight the new NICE guidelines on rehabilitation, setting the expectation that the NHS should take these into account, as well as showcasing the best practice that already exists.

Many hon. and right hon. Members raised data sharing. I am keen to pursue better data sharing on ABI across Departments and the NHS to ensure that our response is joined up and that it improves patient identification, care and support. Rehabilitation is a central focus of our 10-year health plan, which recognises that timely, high-quality rehabilitation reduces long-term disability, improves quality of life and saves significant costs for both health and social care. By embedding rehabilitation into integrated care pathways, expanding community-based services and investing in specialist multidisciplinary teams, the 10-year health plan will ensure that support is available when and where it is needed, including for people who have experienced ABI. That commitment reflects a shift towards person-centred care, helping people to regain skills, to return to work or education, and to live fulfilling lives after serious illness or injury.

Through the 10-year health plan, we are introducing neighbourhood health centres and deploying multi- disciplinary teams to provide holistic support to people with conditions like ABI. We know that every ABI journey is different, and recovery depends on care that reflects individual needs, goals and circumstances. That is why the plan promises to expand personalised care approaches, giving people a say in their care. We commit, therefore, to providing 95% of people with complex needs with a personalised care plan by 2027. That means that people with ABI will benefit from structured and co-ordinated support that is tailored to their needs. The expansion of personal health budgets outlined in the health plan will give people greater flexibility, choice and control over their care.

Our digital transformation commitments will make a real difference too. By improving data sharing between health, social care and rehabilitation services, we can ensure continuity of care and avoid delays. Digital care plans will allow patients and professionals to track progress and adjust goals in real time. Those innovations mean more personalised and co-ordinated care. I am really keen to explore better data collection and sharing between the NHS, patient groups, researchers and those with lived experience across my long-term conditions portfolio, which includes ABI. There are ongoing discussions within the Department on how we might be able to improve the quality of, and access to, health data. I know that there is some great data out there, but too often access to it is too restricted.

The Government will publish the 10-year workforce plan in spring 2026. This will set out action to create a workforce that is ready to deliver the transformed service set out in the 10-year health plan.

My hon. Friend the Member for Blaydon and Consett (Liz Twist) mentioned mental health. NHS talking therapies have a specific pathway for people with long-term physical health conditions, including ABI, and all ICBs are expected to expand services locally by commissioning NHS talking therapies services integrated into physical healthcare pathways, including those for ABI.

Together with the ABI action plan, the 10-year health plan and the 10-year workforce plan will represent a step change in how we support people with ABI. The action plan will deliver a joined-up approach across health, social care, education, justice and beyond, ensuring that rehabilitation and long-term support are no longer fragmented. The 10-year health plan complements this by embedding personalised care planning, expanding community rehabilitation and harnessing digital innovation. These commitments will mean better access to timely, tailored services, improved continuity of care, and a focus on independence and quality of life. By working collaboratively across Government, the NHS and stakeholders will turn these plans into action and deliver the outcomes that people with ABI deserve.

I have covered as many issues as possible. There are some that I do not have immediate information about, but I will write after the debate to the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), about her question on mechanical thrombectomy. By working together right across Government and making sure we have joined-up data and joined-up thinking, we will bring forward the action plan on ABI in the first half of 2026 to deliver the outcomes that people with ABI deserve and need.

[Sir John Hayes]

This has been an extremely good debate. Contributions from across the Chamber have illustrated how strongly Members feel about the need for exactly the kind of strategy that the Minister has confirmed the Government will introduce. It is welcome that the Minister has recommitted to that plan. I offer thanks and a warning. The thanks are because she clearly understands and takes this seriously. The warning is that if we do not see the plan, we will be back, and next time we will be altogether more fierce.

While we have been debating these matters, tens of people, scores of people, have been admitted to hospital with an acquired brain injury—extraordinary. I can tell from all the contributions, including from my great friend on the Front Bench of my party, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), and from Members across the House that the plight of those with ABI is our cause and their needs are our mission. Let us do all we can to ease their plight and meet their needs.

Question put and agreed to.

Resolved,

That this House has considered the potential merits of a comprehensive acquired brain injury action plan.